Imagine you are nine months pregnant and ready to give birth. You feel your contractions start. You are excited and afraid, but mostly you are in pain and praying that everything will go well.
Now imagine that it will take more than four hours to reach the nearest health facility where you can get an assisted delivery. Imagine a journey mostly on foot over mountainous terrain.
This is the reality for many women in Lesotho. Mantebaleng Ntelekoa, a young mother from a rural area in the mountains, remembers: “For all of my three deliveries, I walked two hours to the main road and then continued by minibus to the hospital.
“I usually started walking when my contractions started and it took a long time, because I had to sit down every time I had a contraction. One of my children was born premature at seven months, so I am glad I made it to the hospital.”
Not everyone is as lucky as Mantebaleng. High HIV prevalence and poor access to maternity services have led Lesotho to one of the highest maternal mortality rates in the world, at 620 deaths per 100,000 live births. That’s about twice the global average.
More than 50 per cent of those deaths are attributed to HIV-related complications. The government of Lesotho wants to reduce maternal deaths to 300 per 100,000 live births by 2015. Yet the health situation for many expectant mothers in the small mountain kingdom remains uncertain.
Mortality rates in rural and isolated areas are particularly high. Women may have to travel long distances to the nearest health centre, and face a lack of transport, terrain that is impassable in the winter, as well as user fees at major hospitals.
This keeps many women from accessing antenatal care, lifesaving HIV treatments, and services for the prevention of mother-to-child transmission of HIV.
The Médecins Sans Frontières (MSF) team in Lesotho is supporting rural health facilities to ensure that more women have access to antenatal services and safe deliveries. A doctor, a midwife and several nurses are working in 10 health facilities across the districts of Roma and Semonkong.
At St. Leonard clinic in Semonkong, there is a small maternity ward and a mothers’ waiting lodge. Expectant mothers come to the lodge close to their due date, ensuring that they will be able to deliver their babies with the assistance of a trained midwife. New mothers can stay after giving birth until they are ready to return home with their newborns.
“I sleep in the waiting lodge with the mothers when I am in Semonkong, and the atmosphere is quite amazing,” said MSF midwife Marleen Dermaut. “There is a lot of chatting and giggling. The women feel safe and enjoy each others’ company.
“After all, they are all in the same position, experiencing the wonder of new life. They are away from their duties for a couple of days, and are able to just focus on themselves and their new babies.”
There are around six women at the facility at any time. Since last year, the number of assisted deliveries at St. Leonard almost tripled from seven to 20 deliveries per month. This is likely due to a combination of increased health promotion by centre staff and MSF’s donation of an ambulance.
“The ambulance takes women to the hospital in case of emergencies during labour or after delivery. The hospital is still a two-hour drive away from St. Leonard. It already happened that a baby was born in the ambulance,” said Dermaut.
A team of MSF health promoters regularly goes to communities to test people for HIV and TB, and to improve health education in remote areas. In places with high rates of HIV and TB, testing is crucial so people understand how to spot the diseases, test for them and be able to start treatment right away if necessary.
To reach as many people as possible and to directly involve people living in these areas, MSF trains community health workers to test for HIV and refer people to health facilities if needed.
“The motivation of many people we work with, be it nurses or community counsellors, and the willingness to make changes definitely makes my work here even more rewarding,” said Dermaut.